Cancer Breast Cancer Treatment Chemotherapy for Breast Cancer What to expect when undergoing this treatment By Pam Stephan Pam Stephan is a breast cancer survivor. Learn about our editorial process Pam Stephan Medically reviewed by Medically reviewed by Doru Paul, MD on August 19, 2019 Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. Learn about our Medical Review Board Doru Paul, MD Updated on September 25, 2019 Print Table of Contents View All Table of Contents How It Works Who Gets Chemo Drugs Used Timing Side Effects Possible Complications Chemotherapy involves the use of chemicals that weaken or kill cancer cells and it's a mainstay of treatment for some types of breast cancer. This kind of treatment has long been associated with severe side effects, and while this is a reality of chemo, doctors have learned a lot about how to minimize them while also improving survival rates. Whether your oncologist recommends chemotherapy for you depends on several factors. How It Works Chemotherapy works by interfering with the ability of rapidly growing cells (like cancer cells) to divide or multiply. These powerful drugs kill or delay the growth of cancer cells by disrupting their DNA or protein production, preventing cell division, starving them of nutrients, or blocking hormone receptors. Because most of an adult's normal cells are not actively dividing or multiplying, they aren't affected by chemotherapy. However, bone marrow (where your blood cells are produced), hair follicles, and the lining of the gastrointestinal (GI) tract are all constantly growing. The side effects of chemotherapy drugs are related to its effects on these and other normal tissues. Chemotherapy is a systemic treatment, as opposed to a targeted treatment like surgery or radiation. Verywell / JR Bee Indications Not everyone with breast cancer needs chemotherapy. It's used in four specific instances. Early-Stage Breast Cancer Chemotherapy may be done before and/or after surgery for early-stage cases. Neoadjuvant chemotherapy comes before the primary treatment. It is done to shrink tumors so they're easier to take out, sometimes because the tumor is too large to completely remove. In some cases, it may allow for a lumpectomy instead of a mastectomy. It can also eliminate cancer cells from some lymph nodes so fewer of them need to be removed. It may kill cancer cells that have spread and it reduces the risk of recurrence. Neoadjuvant chemo is common for: Inflammatory breast cancerHER2-positive breast cancerTriple-negative breast cancerHigh-grade tumorsLarge tumorsCancers that have spread to the lymph nodes Adjuvant chemotherapy follows the primary treatment. It's intended to kill any cancer cells that may be left in your body after surgical removal of a tumor, but can't be seen on imaging tests. If left alone, these cells could grow into new tumors. Adjuvant chemotherapy lowers your risk of recurrence. Typically for early-stage breast cancer, this chemotherapy is reserved for those with a high risk of cancer recurrence or metastasis (spreading to other areas of the body), such as when cancer cells have spread to the lymph nodes in the armpit. Hormone therapy may be an alternative option in these cases. Advanced Breast Cancer Chemotherapy is the main treatment for breast cancers that have metastasized (spread) beyond the breast and nearby lymph nodes because targeted treatments such as surgery are no longer adequate. The main goal in advanced cases is to lengthen and improve the quality of life—not to cure the disease. High-Risk Individuals In people who are at especially high risk of developing breast cancer, chemotherapy can be done to reduce their risk. This is called chemoprevention. Because of the risks associated with chemotherapy drugs, this is a step to be carefully considered with your doctor. Chemotherapy Drugs Many drugs are used to fight breast cancer. The most common ones for neoadjuvant and adjuvant therapy include: 5-fluorouracil (5-FU)Anthracyclines, including Adriamycin (doxorubicin) and Ellence (epirubicin)Cytoxan (cyclophosphamide)Paraplatin (carboplatin)Taxanes, including Taxol (paclitaxel) and Taxotere (docetaxel) The most common chemo drugs for advanced breast cancer include: Anthracyclines, including Adriamycin (doxorubicin), Ellence (epirubicin), and pegylated liposomal doxorubicinGezmar (gemcitabine)Halaven (eribulin)Ixempra (ixabepilone)Navelbine (vinorelbine)Platinum agents (cisplatin, carboplatin)Taxanes, including Taxol (paclitaxel), Taxotere (docetaxel), and Abraxane (albumin-bound paclitaxel)Xeloda (capecitabine) How Chemotherapy Is Given Many chemotherapy drugs for breast cancer are given in liquid form, as intravenous infusions or injections, but some are available as pills or tablets. Some drugs may be given alone, and other drugs are combined to work together. When chemo drugs are given in combination, the treatment is called a regimen. Some of the common regimens are: ACT: Adriamycin and Cytoxan followed by TaxolCMF: Cytoxan, methotrexate, and 5-FUAC: Adriamycin (doxorubicin) and CytoxanCAF or FAC: Cytoxan, Adriamycin, and 5-FUCEF or FEC: Cytoxan, Ellence (epirubicin), and 5-FUTC: Taxotere (docetaxel) and Cytoxan What to Expect From Chemotherapy Infusions Timing The frequency of your chemo treatments and the duration of the therapy as a whole depends on what method you are getting, your response to treatment, and other factors. Frequency Typically, chemo infusions are given once every three weeks, and you will need the intervening time to recover your blood counts and allow the drugs to work. Low-dose chemo, such as Taxol, is given weekly, as a smaller dose of drugs will require less recovery time. This will add up to more overall chemotherapy than you would receive on a standard schedule. You may also be given a white blood cell booster shot between infusion sessions. Oral chemo can be taken daily, or as directed. Injections may be given before, during, or after a chemo infusion. Duration Chemotherapy for early-stage breast cancer is generally given for about six months, while weekly low-dose chemotherapy infusions end after 12 weeks. The length and dosage of your treatment will depend on multiple factors. If you're getting infusions, you'll need to budget more time away from work or other activities than just what's needed for infusion sessions to allow (see below). Infusion Sessions Here's a sample schedule to help you plan: Day before: Take pre-chemotherapy medications (if prescribed) to prevent side effects.Day 1: Blood draw, weigh-in, vital signs, check-up, chemo infusionDay 2: Shots to boost blood counts if neededDay 3 and until next cycle: Rest and recovery On the day of your infusion, plan on about four hours in the clinic. Your blood will be drawn and a complete blood count will be done. All your vital signs and weight will be taken, as that determines the amount of your dose of chemo drugs for that day. Your oncologist will review your blood counts and, if they're all in the proper range, you will proceed to the infusion room for your chemotherapy treatment. If your blood counts are too low, further treatment may make you more vulnerable to infections or serious bleeding. Your chemotherapy will be delayed until your counts recover. The Day After Chemo At least one day after each chemotherapy infusion, your blood will be drawn and counted. If your red counts or neutrophils are low, you may be offered shots to boost those counts. Chemotherapy can greatly affect your blood counts because blood cells divide and multiply quickly and are therefore targeted by the drugs. Do not miss these extra appointments, They're essential for recovering from chemo with a healthy immune system and avoiding anemia and neutropenia. Breast Cancer Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. Side Effects The powerful nature of chemo treatment is both its strength and the reason for its bad reputation of side effects. Remember that chemo targets all rapidly growing cells, and, in addition to cancer, that includes cells in your blood, digestive-tract mucous tissues, fingernails, toenails, and hair follicles. Common side effects include: Hair lossNail changesMouth soresLoss of appetiteWeight changesNausea and vomitingDiarrheaIncreased chance of infectionEasy bruisingEasy bleedingFatigueNerve damage"Chemo brain" (memory and concentration problems) Your specific chemotherapy drug or regimen may cause other side effects, as well. These effects will subside after you've finished treatment. Before each treatment, your medical oncologist may want you to take medications to protect against side effects. Be sure to take these on time and as prescribed. Between chemotherapy appointments, if you have trouble dealing with side effects, don't hesitate to call your clinic and ask for help. If you're dehydrated after a treatment, you can ask for an infusion of saline fluid. Other medications may be given along with the saline to help with nausea and vomiting. Your chemotherapy nurses should know a lot of tricks for coping with side effects, so be sure to ask them for help, even if you don't have a scheduled appointment. Write down your symptoms—along with duration, severity, and how often they occur—before you call. That will help them suggest ways to make you feel better. Possible Complications Chemo also carries a risk of long-term complications. You may need to be monitored for these in the years to come: Loss of bone mass (osteopenia and osteoporosis): Hormone-blocking chemotherapy drugs can cause early menopause, and that leads to an elevated risk of bone thinning conditions. Bone density tests and treatment may be necessary.Heart damage: Chemotherapy has a small risk of weakening the heart muscle or causing other problems with the heart.Leukemia (cancer of the blood cells): This side effect is rare but possible and usually occurs years after chemo is completed. Fertility Because specific chemo drugs can trigger medical menopause (which can be temporary or permanent) in premenopausal women, they can cause infertility. If you have any thoughts about future pregnancies, let your oncologist know before you start treatment and ask what your options are. Depending on your age, drug regimen, and dosage, your fertility may return after treatment. However, if there's a chance that you'll become infertile, you need to know before your first chemo infusion. Understanding Medical Menopause Was this page helpful? Thanks for your feedback! Get honest information, the latest research, and support for you or a loved one with breast cancer right to your inbox. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Cancer Society. How Chemotherapy Drugs Work. Revised February 15, 2016. American Cancer Society. Chemotherapy for Breast Cancer. Revised September 18, 2019. Cancer.Net. Chemotherapy. Breastcancer.org. Chemotherapy treatment schedule. Revised March 5, 2015. Cancer.Net. What to Expect When Having Chemotherapy. Approved June 2019. Additional Reading American Cancer Society 2017. Chemotherapy for Breast Cancer. Breastcancer.org. Chemotherapy. Harold Burstein, MD, Ph.D. Adjuvant chemotherapy and trastuzumab (Herceptin) for early stage breast cancer. UpToDate.